about 3 weeks ago my son comes running up to my husband and i screaming and crying that his little sister swallowed a battery...a battery! she runs into the living room (they were playing back in his bedroom) and acts like shes got something in her throat but we couldn't see anything. so what would any concerned parent do? we take her to the emergency room to make sure she's ok. i know that battery acid can be fatal and she's just 2 years old, so we weren't about to wait overnight to see if something would happen (also this was around 8 at night so no doctors office was open where we live). so as we are driving to the hospital we're trying to calm our 5 yr old son down because he thinks the doctors are going to have to cut her open and also making sure our daughter is ok in the meantime. when we finally arrive she gets some x-rays done and the doctor comes in saying all it clear (wow what a relief!!). but recently we received her hospital bill and guess what??!! insurance didn't pay a penny!!!! i called and they told me that the doctor claimed that it wasn't an emergency...do you believe that? ok...did i not just say that battery acid can be fatal? let alone with a two year old! i'm fighting my insurance with this one and i also contacted the hospital and spoke with three different people...luckily the last woman i spoke with said if she were in my situation she would have done the same thing...finally someone on my side! she also does the medical coding and told me she'd send it in again to insurance...bless her heart.
so anyway i was wondering what you guys think and what you would have done in my situation. you know its crazy to think that people murder their children because they don't care and that some get away with it, but i think its beyond crazy that when someone does care about their kid...sometimes it just doesn't matter or pay in their favor in the end.
sorry for the long post, i'm just a little irritated right now.
thanks for listening everyone and have a great day!!!
my daughters visit with x-rays was 800 dollars. might not sound like a lot but to a household of four with one worker...800 too much. and we even have good insurance! its just the point...its ridiculous actually.
dnp2004, thats just terrible what happened to that woman...seriously how do people do the things they do? even when they know what their doing is wrong! i could never work for someone knowing that what i do is hurting people..knowing about it and acting like its no skin off my back because atleast its not happening to me..i seriously wonder how some people sleep at night. i'm just glad everything is going good for her now.
batman24, i just may do that...thanks for the advice!
stinger530, well im glad to hear your little (umm big boy lol) is doing so well. and i hope you get them grandchildren soon . i agree with motherhood being exhausting at times...im tired as we speak, my little ones have been sick for a week now. momma needs some sleep!! hehe.
southern, thanks for the advice also..i kinda figured this wouldn't be easy. life never is, is it? i'll definitely talk to them and send the request in.
I also think you did the right thing and I'd contest the denial. Hopefully it will be overturned. I don't have a lot of faith in insurance companies so I just get whatever health care I feel we need, using whatever provider/specialist I feel is necessary and pay out of pocket if I can't get them to cover it. My family's health is too important not to look at it that way and I'm too old and tired to get all worked up over it.
Whatever you do, DON'T GIVE UP! Pursue this until the very end - even if you have to get a lawyer. Insurance companies have no right to walk over people, especially when you had a legitimate reason for seeking emergency care. What a crock!
I think you did the right thing, and if I were in your situation, I would have taken my child to the ER, too. Not an emergency? What the hell was that doctor thinking? He needs to feel the brunt of this, too. (Though I don't know how you'd go about achieving that.) If he doesn't consider this situation as an emergency, I'd hate to see what else isn't one in his warped little world!
I think it sets a very bad precedent when insurance companies are allowed to deny claims from people involved in car accidents (especially rollovers!). People may hear too many stories like this and fear they should avoid potentially expensive evaluation and treatment with their symptoms seemminor. I know too many people who are fighting insurance companies over fraudulent denials. I use the word fraudulent because in the cases I dealt with:
Customers made policy payments on time.
Customers did not violate any terms or conditions of their insurance policies.
Customers followed Federal, State & professional medical association recommendations.
Despite all of the above, the insurance company denied claims.
The insurance company violated their own written policies.
The insurance company refused to offer policy holder refunds for services that were requested but never rendered.
If that is not fraud, I don't what is. Unlike most types of fraud insurance fraud can get you permanently injured or killed. Do any of you think the situation will get any better soon? Brokerage firms, banks and insurance companies have been way too intermingled and damaged by the current economic crisis!
Below is a link to an article that I just read on the topic of "minor head injuries".
'Minor' head injuries can turn serious rapidly, experts say
I would have done the exact same thing- taken the child to the ER. If I were thinking straight, I may have phoned the Ped. first- but...
I agree- appeal. And keep appealing- and have your child's pediatrician send a letter... and generally be a royal pain in their gluteus maximus until they realize that just paying for the services is alot less costly and time consuming than dealing with you. the squeaky wheel gets the payment. Been there, done that. It's a pain- but...
The other face to this issue is the physician and the hospital, I would contact a hospital administrator and give that person my story, asking that the Dr. be approached concerning his interpretation of what constitutes an emergency involving a w year old ingesting foreign objects. And what is the quality insurance people doing with reviewing such diagnosis and coding of same? I would remind this person that the physician's failure to acknowledge the seriousness of early identification of childhood ingestion of battery acid is a litigious situation which will require either a rebilling so that the insurance company pays or the hospital will be identified as a responsible party in litigation. nanacarol
P.S. If worded and presented in a very calm professional fashion, it will have very positive effects in getting your bill re submitted and policies changed.
Oh I would appeal, call, email, appeal, call until I was blue in the face. Get the name of who you talk to, get the name of the CEO, and NEVER let it drop. FInd out what coding was used, a matter of a decimal point typo can make all the difference. I believe every denial deserves appeal.
My vet told me of a full grown dog who died of zinc poisoning from swallowing a few pennies. Your child swallowed something a WHOLE lot more potentially damaging. You appeal this stupid denial-please!!!!
Oh I would appeal, call, email, appeal, call until I was blue in the face. Get the name of who you talk to, get the name of the CEO, and NEVER let it drop. FInd out what coding was used, a matter of a decimal point typo can make all the difference. I believe every denial deserves appeal.
My vet told me of a full grown dog who died of zinc poisoning from swallowing a few pennies. Your child swallowed something a WHOLE lot more potentially damaging. You appeal this stupid denial-please!!!!
After I got it in writing from the ER doc, and your pediatrician, I would gather family and friends, perhaps an elected official of some sorts, notify and invite the news media and papers, gather in a very public place, and make a REALLY BID SCENE, MAKE LARGE POSTERS WITH THE NAME OF THE INSURANCE COMPANY AND THE PERSON RESPONSIBLE FOR DENYING YOUR CLAIM AND GET IN THEIR FACE IN A BIG WAY!!!
Insurance companies are already getting a bad name and some bad publicity already. Dont' let them off of the hot seat. Keep up the pressure!! Nice guys finish last. JMHO and my NY $0.02.
May I suggest that when you send a letter to the ins co detailing why they must pay, don't ask them to pay. Lay out in no uncertain terms that they are *obligated* to pay under the terms of the policy - and lay out that you met your obligations under the policy, now they must meet theirs. Put the burden on them to explain why they aren't paying. Don't be nasty, just lay out the facts in the most organized, concise, and professional way you can.
Now (this is the important part) you also need to send a copy of this letter to your state's Board of Insurance (or whatever your state's regulatory body is). Put in the letter to the ins co that you are copying the letter to the Board of Insurance. That way, TPTB are made aware that the ins co is likely denying your claim for fraudulent reasons.
This worked for me, when my insurance attempted to deny coverage for cataract surgery. My ex-husband, who is an attorney, helped me write the letter (he called it a "Nasty-gram", sending one is apparently a common tactic) and suggested the cc: to the Board of Insurance.
The insurance company approved coverage for my surgery the day they got my letter.
HTH. They really should be paying your claim. Good luck.
It is 2009 in the United States of America. Per capita the United States spends more money on healthcare than any other nation on earth. Yet we have to resort to appeals, Boards of Insurance, Nasty-grams, lawsuits, large posters, etc... Just to make sure an insurance company honors their obligations to paying policyholders!
Each case like these make the push for Universal Health Care that much stronger.
once again, thank you all for your wonderful advice! the hospital has coded the claim differently and resubmitted it...so now i just wait. i hope this gets settled shortly and i don't have to worry about this stupid bill anymore!! i will keep everyone posted. thank you again!
What?!?! Even the suspicion that your child swallowed something poisonous like that is an emergent situation. Obviously, you should go to the emergency ward. If insurance companies aren't paying in situations like this, it's just not cost effective because then parents will wait until the child is having some kind of horrible symptom that confirms that something poisonous was indeed swallowed and then the cost of treatment will be far, far higher.
Unlike most types of fraud insurance fraud can get you permanently injured or killed. Do any of you think the situation will get any better soon? Brokerage firms, banks and insurance companies have been way too intermingled and damaged by the current economic crisis! 
Nina2bRN
68 Posts
my daughters visit with x-rays was 800 dollars. might not sound like a lot but to a household of four with one worker...800 too much. and we even have good insurance! its just the point...its ridiculous actually.
dnp2004, thats just terrible what happened to that woman...seriously how do people do the things they do? even when they know what their doing is wrong! i could never work for someone knowing that what i do is hurting people..knowing about it and acting like its no skin off my back because atleast its not happening to me..i seriously wonder how some people sleep at night. i'm just glad everything is going good for her now.
batman24, i just may do that...thanks for the advice!
stinger530, well im glad to hear your little (umm big boy lol) is doing so well. and i hope you get them grandchildren soon
. i agree with motherhood being exhausting at times...im tired as we speak, my little ones have been sick for a week now. momma needs some sleep!! hehe.
southern, thanks for the advice also..i kinda figured this wouldn't be easy. life never is, is it? i'll definitely talk to them and send the request in.